Assessing health literacy and its impacts among people accessing unguided internet-delivered cognitive behaviour therapy for depression and anxiety: a treatment-seeking cohort study

Objective: This study examined the health literacy of individuals accessing unguided internet-delivered cognitive behaviour therapy (iCBT) for depression and/or anxiety, and its association with sociodemographics, clinical characteristics, and treatment outcomes. Methods: Adults (N = 570) in an unguided iCBT trial completed measures of sociodemographics, past/concurrent mental health treatment use, quality-of-care, depression and anxiety symptoms, and health literacy across the nine Health Literacy Questionnaire (HLQ) domains. Results: Higher average scores were observed for HLQ domains 'Appraisal of health information' and 'Understand health information well enough to know what to do next' with lower scores in 'Ability to actively engage with healthcare providers' and 'Navigating the healthcare system'. Lower scores on one or more HLQ domains were associated with younger age, female gender, culturally and linguistically diverse backgrounds, speaking a main language other than English, higher baseline depression and anxiety symptoms, use of crisis and emergency services, non-contact with general practitioners or other health professionals, and poorer quality-of-care (ps > 0.025). Discussion: Individuals with diverse health literacy strengths and challenges appear to access and benefit from unguided iCBT, though research is needed to characterise health literacy and its impacts in related settings.